Methods and compositions for generating epicardium cells

ABSTRACT

Provided are methods and products for obtaining cardiovascular lineage cells from hPSCs. The method for obtaining a cardiomyocyte lineage or an epicardial lineage cell population from human pluripotent stem cells (hPSCs) comprises one or more of the following steps: (a) contacting BMP component primed hPSCs with a cardiovascular mesoderm programming cocktail suitable for inducing the hPSCs to differentiate to a cardiovascular mesoderm cell population under conditions suitable for the programming cocktail to penetrate the hPSCs and culturing the contacted hPSCs for a period of time to generate a KDR+ and PDGFRalpha+ cardiovascular mesoderm cell population; (b) contacting the cardiovascular mesoderm cell population with a cardiovascular progenitor specification cocktail suitable to specify a NKX2-5+ or WT1+ cardiovascular progenitor cell population under conditions suitable for the specification cocktail to penetrate the cardiovascular mesoderm cell population and culturing the contacted cardiovascular mesoderm cell population for a period of time to generate a NKX2-5+ or WT1+ cardiovascular progenitor cell population; and (d) contacting the cardiovascular progenitor cell population with a maturation cocktail under conditions suitable for the maturation cocktail to penetrate the cardiovascular progenitor cell population and culturing the contacted cardiovascular progenitor population for a period of time to produce a cardiovascular population optionally cardiomyocyte lineage cells expressing cardiac troponin T (cTnT) and/or SIRPA and/or epicardial lineage cells expressing WT1.

RELATED APPLICATIONS

This is a Patent Cooperation Treaty Application which claims the benefitof 35 U.S.C. §119 based on the priority of U.S. Provisional PatentApplication No. 61/877,618, filed Sep. 13, 2013 which is incorporatedherein by reference in its entirety.

FIELD

The disclosure provides methods and compositions for producingcardiovascular lineage cells from PSCs, including hPSCs, as well asmethods and compositions for producing cardiomyocyte and epicardiallineage cell populations.

BACKGROUND

Over the past five years, progress has been made in our ability todirect the differentiation of human embryonic (hESCs) and inducedpluripotent stem cells (hiPSCs) (collectively referred to as humanpluripotent stem cells; hPSCs) to specific cells types, including thoseof the cardiovascular lineages^(1, 2). This success is largely based onthe translation of our understanding of lineage development and tissueformation in model organisms to the hPSC differentiation cultures¹. Withrespect to the cardiovascular system, this approach has led to theestablishment of differentiation protocols that recapitulate the keystages of development including the formation of a primitive streak(PS)-like population, the induction of cardiovascular mesoderm and thespecification of the cardiovascular lineages from this mesoderm^(3, 4).Developmental biology has also informed us on key regulatory pathwaysthat control this developmental progression including the requirementfor activin A/nodal and BMP4 signaling to generate the PS/mesodermpopulation and the need to inhibit β-catenin dependent Wnt signaling tospecify the mesoderm to a cardiovascular fate⁴. Recent studies haveidentified surface markers specific for cell populations representingdifferent stages of cardiovascular development. This marker set includesKDR and PDGFRα found on cardiovascular mesoderm′ and SIRPA present oncardiovascular progenitors and differentiated cardiomyocytes⁶. Bymonitoring the emergence of the KDR⁺PDGFRα⁺ population, it was shownthat different hPSC lines require different concentrations of activin Aand BMP4 for optimal mesoderm induction and cardiomyocyte development′.

The epicardial lineage is derived from a structure known as theproepicardial organ (PEO) that develops adjacent to the heart atapproximately embryonic stage (E) 9.5 in the mouse⁷. Pro-epicardialcells characterized by the expression of the transcription factors WilmsTumor 1 (WT1) and TBX18, migrate from the PEO to the early heart tubeduring the process of looping and rapidly envelope it to form an outerepithelial layer, known as the epicardium. The epicardium is essentialfor normal heart development and functions to support rapidproliferation of the ventricular cells and the formation of compact zonemyocardium. It is also the source of several major cell types of theheart including cardiac fibroblasts, coronary vascular smooth musclecells and to a lesser extent endothelial cells. These differentiatedprogeny are referred to as epicardial-derived cells (EPDCs) and arederived through an epithelial-to-mesenchymal transition (EMT) of theepicardium. Lineage tracing studies suggest that the epicardium is alsoa source of cardiomyocytes^(8, 9). However, the interpretation of thesestudies has been questioned given the uncertainty of the epicardialspecificity of the gene used for the tracing experiments¹⁰.

The epicardium produces a number of factors including retinoic acid(RA), fibroblast growth factors (FGFs) and insulin-like growth factors(IGFs), several of which are essential for the transient phase ofventricular myocyte proliferation necessary for the formation of compactzone myocardium. Recent studies have shown that IGF2 is the criticalepicardium-derived factor that promotes ventricular proliferation¹¹ andthat RA mediates this function indirectly through activation oferythropoietin (EPO) in the liver, which in turn induces IGF2 in theepicardium¹². Evidence also exists for myocardial regulation of theepicardium through the activity of thymosin β4 (Tβ4), a G-actin monomerbinding protein¹³. Tβ4 is produced by the developing myocardium and isrequired for proper epicardial development and integrity.

While the normal adult epicardium does not express WT1, TBX18 orRALDH2¹⁴, injury such as myocardial infarction will lead to theupregulation of this ‘fetal’ gene program, as well as to proliferationof cells within the population and the reactivation of EMT. Injection ofTβ4 during infarction enhances these changes and prevents myocardialdeath, likely through the production of paracrine factors from theactivated epicardial cells^(14, 15). Lineage-tracing studies in theadult suggest that this activated epicardium has some capacity togenerate new cardiomyocytes and that this cardiogenic potential isaugmented by priming of the pre-infarcted heart with Tβ4¹⁵. As with thefetal studies, however, this concept is controversial, as recent studiesfailed to demonstrate any contribution of the epicardium to themyocardium of the infarcted, Tβ4-treated heart¹⁴.

In vitro studies have shown that epicardial cells in explant cultureswill undergo EMT and give rise to EPDCs in response to Notch¹⁶,TGFβ¹⁷⁻¹⁹ and PDGFBB²⁰ or Tβ4¹⁵. Epicardial cells from infarcted animalsprimed with Tβ4 in vivo differentiate to cells that expresscardiomyocyte markers in explant cultures¹⁵.

Although these advances have enabled the efficient and scalablederivation of cardiomyocytes from hPSCs, these differentiatedpopulations are not optimal for many applications, as they containimmature cells and the proportion of different cardiac lineage cellsincluding myocardial and epicardial within them is not well defined. Torealize the potential of hPSCs in cardiovascular research andtherapeutic applications, it will likely be necessary to develop culturesystems and engineered tissues that more accurately represent the humanheart.

SUMMARY

An aspect includes a method of obtaining a cardiovascular lineage cellpopulation, optionally cardiomyocyte lineage cell population or anepicardial lineage cell population from human pluripotent stem cells(hPSCs) comprising the steps: (a) contacting BMP component primed hPSCswith a cardiovascular mesoderm programming cocktail suitable forinducing the hPSCs to differentiate to a cardiovascular mesoderm cellpopulation under conditions suitable for the programming cocktail topenetrate the hPSCs and culturing the contacted hPSCs for a period oftime to generate a KDR+ and PDGFRα+ cardiovascular mesoderm cellpopulation; (b) contacting the cardiovascular mesoderm cell populationwith a cardiovascular progenitor specification cocktail suitable tospecify a NKX2-5+ or WT1+ cardiovascular progenitor cell populationunder conditions suitable for the specification cocktail to penetratethe cardiovascular mesoderm cell population and culturing the contactedcardiovascular mesoderm cell population for a period of time to generatea NKX2-5+ or WT1+ cardiovascular progenitor cell population; and (d)contacting the cardiovascular progenitor cell population with amaturation cocktail under conditions suitable for the maturationcocktail to penetrate the cardiovascular progenitor cell population andculturing the contacted cardiovascular progenitor population for aperiod of time to produce a cardiovascular lineage population optionallya cardiomyocyte lineage cell population expressing cardiac troponin T(cTnT) and/or SIRPA and/or an epicardial lineage cell populationoptionally expressing WT1 and/or comprising epicardial derived cells(EPDCs).

Other features and advantages of the present disclosure will becomeapparent from the following detailed description. It should beunderstood, however, that the detailed description and the specificexamples while indicating preferred embodiments of the disclosure aregiven by way of illustration only, since various changes andmodifications within the spirit and scope of the disclosure will becomeapparent to those skilled in the art from this detailed description.

BRIEF DESCRIPTION OF THE DRAWINGS

An embodiment of the present disclosure will now be described inrelation to the drawings in which:

FIG. 1. Cardiomyocyte specification from hESCs. Scheme of the protocolused to differentiate hESCs towards the cardiomyocyte lineagehighlighting the three main stages of development: 1) mesoderminduction, 2) cardiovascular specification and 3) maturation. Cells fromActivinA/BMP4-induced day 4 embryoid bodies (EBs) are plated as amonolayer on gelatin coated wells. The BMP pathway is manipulated for a48-hour period (D4-D6) in the presence of VEGF (5 ng/ml), theActivin/Nodal (SB-431542 5.4 μM) and Wnt (DKK1 150 ng/ml) inhibitors.Following specification, the cultures were maintained in VEGF for 9 daysand then analyzed for the presence of cTnT+ cardiomyocytes by flowcytometry.

FIG. 2. BMP4 regulates the specification of cardiomyocytes fromhESC-derived mesoderm. (a) Flow cytometric analyses showing the presenceof the KDR+ and PDGFRα+ populations at day 4 and day 5 and the cTnT+expression on day 15 of culture following no treatment (control),treatment with BMP4 (10 ng/ml) or the BMP4 inhibitor Noggin (400 ng/ml).(b) Total cell numbers per well at day 15 in the cultures treated asabove. Error bars represent standard deviation from the mean from threeexperiments.

FIG. 3. BMP signaling dose-dependently specifies cardiomyocytes fromhESC-derived mesoderm. Graphical representation of flow cytometryanalyses indicating the percent cTnT⁺ cells in day 15 cultures generatedfrom populations treated with the indicated amounts of BMP4 or Noggin.NT=no treatment. Bars represent standard deviation from the mean of thevalues from three independent experiments (N=3); *P≦0.05, **P≦0.01 whencompared to no treatment.

FIG. 4. qRT-PCR expression of myocardial and epicardial markers afterBMP treatment. qRT-PCR-based expression of the indicated genes at days6, 8, 10, 12, and 15 of culture in populations generated from notreatment (control), BMP4 treated or Noggin (400 ng/ml) treated cells.Values are relative to the housekeeping gene TBP. Error bars representstandard deviation from the mean of the values from three independentexperiments (N=3); *P≦0.05, **P≦0.01 when compared to no treatment.

FIG. 5. BMP4-induced cells express the epicardial marker WT1.BFluorescent immunostaining analyses showing the presence of cTnT and WT1in no treatment (control), BMP4 (10 ng/ml) and Noggin (400 ng/ml)treated cells at day 15 of culture. DAPI staining shows cell nuclei

FIG. 6. WT1⁺ epicardium generate epithelial sheets following passage.(a) Phase contrast microscopy and fluorescent immunostaining showing themorphology of the BMP4 (10 ng/ml) treated epicardial cells and thepresence of ZO1 and WT1 at day 15 of culture. DAPI staining shows cellnuclei. Scale bar represents 100 μM. (b) Phase contrast microscopy andfluorescent immunostaining showing the morphology of the BMP4 (10 ng/ml)treated epicardial cells and the presence of ZO1 and WT1 4 days afterpassage (day 15+4). DAPI staining shows cell nuclei. Scale barrepresents 100 μM.

FIG. 7. Flow cytometry analysis for the expression of cell surfacemarkers in day 15 cardiomyocytes, day 15 epicardium, and post-passageepicardium. Flow cytometric analyses of the indicated markers on day 15cardiomyocytes, day 15 Epicardium and epicardium 4 days followingpassage (Day 15+4). Gray filled histogram indicates unstainedfluorescence intensity.

FIG. 8. Cardiomyocytes and epicardial cells are derived from day 4PDGFRα⁺ mesoderm. (a) PDGFR⁺ and PDGFR⁻ populations were isolated fromday 4 EBs and the cells were plated under conditions that supportcardiomyocyte or WT1⁺ cell development. (b) Flow cytometric analysesshowing cTnT⁺ cells in day 15 cultures plated under pro-cardiogenicconditions. (c) Fluorescent immunostaining for the presence of WT1positive cells in day 15 cultures plated under pro-epicardial inducingconditions (BMP4). DAPI staining shows the cell nuclei. (d)qRT-PCR-based expression analyses of the epicardial markers WT1 andTBX18 in the sorted populations at D15 following culture underpro-epicardial conditions. Values are fold change compared to theunsorted cultures. Error bars represent standard deviation the mean fromthe values from three independent experiments (N=3); *P≦0.05, **P≦0.01from unsorted cultures.

FIG. 9. BMP and Wnt signaling modulate cardiomyocyte and epicardial cellspecification. (a) Graphical depiction of flow cytometric analysesshowing the percent cTnT+ cells in day 15 cultures generated fromuntreated cells (control) or cells treated with either BMP4 (10 ng/ml)or the BMP inhibitor Dorsomorphin (DM 4 μM) in combination with theindicated amounts of DKK1 or CHIR. Error bars represent standarddeviation from the mean of the values from three independent experiments(N=3); *P≦0.05, **P≦0.01 when compared to the ‘no Wnt treatment’ (NT)control in context of the indicated manipulation of the BMP pathway. (b)qRT-PCR-based analyses of WT1 expression on day 15 cultures generatedfrom untreated cells (control) or cells treated with either BMP4 (10ng/ml) or DM (4 μM) in combination with the indicated amounts of DKK orCHIR. Values are relative to the housekeeping gene TBP. Error barsrepresent standard deviation from the mean of the values from threeindependent experiments (N=3); *P≦0.05, **P≦0.01 when compared to the‘no Wnt treatment’ (NT) control in the context of the indicatedmanipulation of the BMP pathway. (c) Flow cytometry analyses showingpercent cTnT+ cells and qRT-PCR analyses for WT1 expression in day 15cultures generated from untreated cells (control) or cells treated witheither BMP4 (10 ng/ml) or DM (4 μM) in combination with the indicatedamounts of XAV939 (XAV). Error bars represent standard deviation fromthe mean of the values from three independent experiments (N=3);*P≦0.05, **P≦0.01 when compared to no Wnt treatment (see FIGS. 9a and 9b) in the context of the specific BMP treatment. (d) Flow cytometryanalyses showing percent cTnT+ cells and qRT-PCR analyses of WT1expression in day 15 cultures generated from untreated cells (control)or cells treated with either BMP4 (10 ng/ml) or DM (4 μM) in combinationwith the indicated amounts of IWP2. Error bars represent standarddeviation from the mean of the values from three independent experiments(N=3); *P≦0.05, **P≦0.01 when compared to no Wnt treatment (see FIGS. 9aand 9b ) in the context of the specific BMP treatment.

FIG. 10. Generation of WT1⁺ epicardial cells from Sendai virus-derivedhiPSCs and H7 hESCs. (a) Fluorescent immunostaining showing theexpression of WT1 and ZO1 in a hiPSC-derived epicardial cultures. DAPIstaining shows cell nuclei. Scheme indicates timing of manipulations andanalysis. (b) Fluorescent immunostaining showing the expression of WT1and ZO1 in a H7 hESC-derived epicardial cultures. DAPI staining showscell nuclei. Scheme indicates timing of manipulations and analysis.

FIG. 11. WT1⁺ epicardial cells undergo EMT in response to TGFβ1 and bFGFtreatment. (a) Scheme of the protocol used for EMT induction. Day 15WT1+ cultures are passaged, allowed to settle for 1 day and then treatedwith TGFβ1 (5 ng/ml) for 4 days followed by no treatment (TGFβ),sequential treatment with TGFμ1 (5 ng/ml) for 4 days followed by bFGF(10 ng/ml) for 4 days (TGFβ+bFGF), or bFGF (10 ng/ml) treatment for 8days (bFGF). No treatment of the cultures serves as a control. (b) Flowcytometric analyses of cultures 8 days following the initiation of EMTfor the cell surface mesenchymal marker CD90. Gray filled histogramindicates control culture fluorescence intensity. (c) qRT-PCR-basedexpression of the epicardial gene WT1 and the EMT-induced genes SNAI1and SNAI2 on days 2, 4, 6 and 8 after EMT initiation. Values areexpressed as fold change to experiment-matched pre-passaged day 15 WT1+cultures. Error bars represent standard deviation from the mean of thevalues from three independent experiments (N=3); *P≦0.05, **P≦0.01compared to no treatment control.

FIG. 12. WT1 and ZO1 expression is lost in response to EMT. Phasecontrast and fluorescent immunostaining showing cell morphology and theexpression of ZO1 and WT1 proteins in epicardial cultures 8 days afterEMT initiation with the indicated factors. DAPI staining shows cellnuclei.

FIG. 13. EPDCs display characteristic expression of fibroblasts andvascular smooth muscle cell markers by fluorescent immunostaining.Fluorescent immunostaining showing α-Smooth muscle actin (SMA) andVimentin (VIM) protein in cultures 8 days after EMT initiation with theindicated factors. DAPI staining shows cell nuclei.

FIG. 14. EPDCs display characteristic expression of fibroblasts andvascular smooth muscle cell markers by qRT-PCR. qRT-PCR-based expressionanalyses of the smooth muscle genes CCN1, MYH11, TAGLN and SMTN and theepicardial/cardiac fibroblast gene TCF21 in the indicated cultures 8days after EMT initiation. Values are expressed as fold change toexperiment-matched pre-passaged day 15 WT1⁺ epicardium cultures. Errorbars represent standard deviation from the mean of the values from threeindependent experiments (N=3); *P≦0.05, **P≦0.01 compared to notreatment control cultures.

FIG. 15. hESC epicardial-derived smooth muscle-like cells generateaction potentials when stimulated.

(a) The total proportion of actively cycling cells in EMT-inducedcultures was measured for the indicated treatments. Treatment withTGFβ+bFGF generated populations with the largest proportion of activelycycling cells in response to agonists. Bars represent standard error ofthe mean; N=3/group; *P<0.05, **P<0.01 compared by one-way ANOVA withTukey post hoc test.(b) The frequency of calcium cycles in actively cycling cells in theconditions as indicated at baseline and after NE and PE addition.Stacked bars represent the contribution to frequency of calcium cyclingduring baseline recording (hatched lines), and after NE (white) or PE(black) treatment.(c) The amplitude of calcium transients after NE and PE addition in theEMT induced cultures. No Treatment NE N=6 cells, PE N=4 cells; TGFβ NEN=6 cells, PE N=12 cells; TGFβ+bFGF NE N=13 cells, PE N=25 cells.*P<0.05 compared by one-way ANOVA with Tukey post hoc test.(d) The duration of calcium transients after NE and PE addition in theEMT induced cultures. No Treatment NE N=6 cells, PE N=4 cells; TGFβNEN=6 cells, PE N=12 cells; TGFβ+bFGF NE N=13 cells, PE N=25 cells.**P<0.01 compared by one-way ANOVA with Tukey post hoc test.

FIG. 16. hESC epicardial-derived fibroblast-like cells invade 3D gels.

(a) Representative fields of view in the XY plane (top view) and 3Dreconstruction (side view) of the matrigel invasion assay on D8 afterEMT induction.(b) Maximum matrigel invasion depth on D8 following EMT initiation. Barsrepresent standard error of the mean of the values from threeindependent experiments (N=3); **P≦0.01 compared to non-treated controlsas analyzed by Student's T-test.

FIG. 17. WT1⁺ epicardial cells upregulate ALDH1A2 expression and displayaldehyde dehydrogenase activity following passage. (a) qRT-PCR-basedexpression analyses of ALDH1A1, ALDH1A2 and ALDH1A3 in D15 WT⁺epicardial cultures and Day 15+8 post-passage non-treated epicardialcultures. Values are relative to the housekeeping gene TBP. Error barsrepresent standard deviation from the mean of the values from threeindependent experiments (N=3); *P≦0.05, **P≦0.01 compared to ALDH1A2expression levels. (b) qRT-PCR-based expression analyses of ALDH1A2 ondays 2, 4, 6 and 8 following the initiation of EMT. Values are expressedas fold change to experiment-matched pre-passaged day 15 WT1⁺ epicardialcultures. Error bars represent standard deviation from the mean of thevalues from three independent experiments (N=3); *P≦0.05, **P≦0.01compared to no treatment control cultures. (c) Flow cytometric analysesof Aldefluor on day 15 populations generated from cells treated fromdays 4 to 6 with DM (non-cardiac, non-epicardial), BMP4+XAV(cardiomyocytes) or BMP4+CHIR (WT1⁺ epicardial cells). (d) Flowcytometry analyses of Aldefluor on WT1⁺ epicardium-derived cultures 8days following the initiation of EMT with the indicated treatments.

FIG. 18. Differentiation scheme showing cardiomyocyte, epicardium, andEPDC development from hPSC-derived mesoderm.

DETAILED DESCRIPTION OF THE DISCLOSURE I. Definitions

The term “activin component” as used herein means one or morecomponents, or a composition comprising said component(s), optionally aculture medium comprising a molecule that activates nodal signaltransduction, optionally Activin A activity such as Activin A and/ornodal.

The term “activin” or “ActA” as used herein refers to “Activin A”, (forexample Gene ID: 3624), for example human activinA, as well as activeconjugates and fragments thereof, optionally including naturallyoccurring active conjugates and fragments, that can for example activatenodal signal transduction as well as active conjugates and fragmentsthereof, including naturally occurring active conjugates and fragments.

The term “activin/nodal inhibitor” and/or “activin/nodal/TGF-βRinhibitor” as used herein means any molecule that inhibits signal of theactivin/nodal pathway and particularly any molecule that inhibitsreceptors ALK4, ALK7 and/or TGF-βRI, including but not limited toSB431542 (Sigma Aldrich) A83-01 (Tocris, 2929), D 4476, GW 788388, LY364947, RepSox, SB 505124, SB 525334 (Sigma Aldrich), and SD 208.

The term “wnt inhibitor” as used herein means any agent, including anycompound and/or protein that inhibits wnt signaling, including but notlimited to wnt antagonists that bind either to the Wnt ligand itself, orto Wnt receptors, such as Dickkopf (Dkk) proteins, Wnt InhibitoryFactor-1 (WIF-1), and secreted Frizzled-Related Proteins (sFRPs), aswell as wnt inverse agonists (e.g. an agent that binds to the samereceptor as an agonist but induces a pharmacological response oppositeto that of an agonist). Examples of Wnt inhibitors include XAV939, IWP2, an inhibitor of wnt processing, and iCRT14, which is a potentinhibitor of β-catenin-responsive transcription (CRT), both of which areavailable from Tocris Bioscience, as well as combinations thereof.

The term “wnt component” as used herein means any molecule thatactivates wnt/beta-catenin receptor signaling in a cardiovascular celland includes for example Wnt3a and as well as GSK3 selective inhibitorssuch as CHIR99021 (Stemolecule™ CHIR99021 Stemgent),6-Bromolndirubin-3′-Oxime (BIO) (Cayman Chemical (cat:13123)), orStemolecule™ BIO from Stemgent (cat:04003). CHIR99021 is a selectiveinhibitor of GSK3. The GSK3 selective inhibitors contemplated are forexample selective inhibitors for GSK-3a/β in the Wnt signaling pathway.

The term “FGF component” as used herein means a molecule such as acytokine, including for example FGF, or a small molecule, that activatesa FGF signalling pathway, e.g. binds and activates a FGF receptor. Theterm “FGF” as used herein refers to any fibroblast growth factor, forexample human FGF1 (Gene ID: 2246), FGF2 (also known as bFGF; Gene ID:2247), FGF3 (Gene ID: 2248), FGF4 (Gene ID: 2249), FGF5 (Gene ID: 2250),FGF6 (Gene ID: 2251), FGF7 (Gene ID: 2252), FGF8 (Gene ID: 2253), FGF9(Gene ID: 2254) and FGF10 (Gene ID: 2255) optionally including activeconjugates and fragments thereof, including naturally occurring activeconjugates and fragments. In certain embodiments, FGF is bFGF, FGF10,FGF4 and/or FGF2.

The term “BMP component” as used herein means any molecule optionallyany BMP or growth and differentiation factor (GDF) that activates thereceptor for BMP4, including for example BMP4 and BMP2,

The term “BMP inhibitor” as used herein means any inhibitor of BMPsignaling and includes for example a type 1 BMP receptor inhibitor, BMPligands and/or soluble BMP receptors. Optionally selected fromdorsomorphin (DM), noggin, Chordin, LDN-193189, soluble BMPR1a, and/orsoluble BMPR1b.

The term “BMP4” (for example Gene ID: 652) as used herein refers to BoneMorphogenetic Protein 4, for example human BMP4, as well as activeconjugates and fragments thereof, optionally including naturallyoccurring active conjugates and fragments, that can for example activateBMP4 receptor signaling.

The term “BMP component primed hPSCs” as used herein means hPSCs thathave been contacted with a BMP component for at least 12 hours,preferably at least 24 hours or more preferably at least 48 hours.Typically these cells are in embryoid bodies or monolayer cultures.

The term “cardiovascular lineage cell” refers to a cell that expresses acardiovascular mesoderm, cardiomyocyte or an epicardial gene expressionpattern, for example expresses KDR, PDGFRα, NK2 homeobox 5 (NKX2-5),cardiac troponin T (cTnT), signal-regulatory protein alpha (SIRPA) orWilms Tumour 1 (WT1) and is primed or has the capacity to differentiateinto a cardiomyocyte lineage cell and/or an epicardial lineage cell oran epicardial derived cell (EPDC) such as a vascular smooth muscle likecell or a fibroblast like cell as described herein.

The term “cardiovascular mesoderm programming cocktail” as used hereinis a combination comprising a BMP component and an activin component andoptionally a FGF component and the cardiovascular mesoderm programmingcocktail is contacted with the hPSCs for about 3 to about 5 days.

The term “cardiovascular progenitor specification cocktail” as usedherein means a one or more components, a composition comprising saidcomponent(s), for specifying a NKX2-5+ or WT1+ cardiovascular progenitorcell population for example a cardiomyocyte promoting component forspecifying a NKX2-5+ cardiomyocyte lineage progenitor cell population ora epicardial promoting component for specifying a WT1+ epicardiallineage progenitor cell population.

The term “cardiomyocyte promoting component” as used herein means one ormore components or a composition comprising said component(s), said oneor more components, comprising: 1) a combination of a Wnt inhibitoroptionally selected from, DKK1, XAV939 and IWP2 and a BMP component,optionally wherein the BMP component is BMP4 at a concentration of atleast 0.01 ng/mL, at least 0.05 ng/mL, at least 0.1 ng/mL, at least 0.5ng/mL, at least 1.25 ng/mL, at least 2.5 ng/mL, at least 5 ng/mL, butless than 10 ng/ml, or less than 15 ng/mL or preferably about 0.5 ng/mL;or 2) a BMP inhibitor, such as noggin or dorsomorphin, for examplenoggin at a concentration of less than 200 ng/mL, less than 150 ng/mL,less than 100 ng/mL, less than 50 ng/mL, or less than 25 ng/mL and/orgreater than 12.5 ng/mL; 3) a Wnt inhibitor, for example wherein thereis sufficient endogenous BMP4 produced and/or 4) a cardiomyocyte lineageconcentration of a BMP component, optionally BMP4 for example whereinthe BMP4 is at a concentration of less than 0.63 ng/mL, less than 0.5ng/mL, less than 0.4 ng/mL, or less than 0.3 ng/mL. The effectiveconcentration and/or combination can be determined by monitoring andoptimizing for NKX2-5 expression and/or TNNT2/cTnT expression.

The term “epicardial lineage promoting component” as used herein meansone or more components or a composition comprising said component(s),the one or more components comprising an epicardial lineage promotingconcentration of a BMP component, optionally BMP4, and optionally a Wntcomponent. Optionally, the BMP4 is at a concentration of at least 1.25ng/mL, at least 2.5 ng/mL, at least 5 ng/mL or at least 10 ng/mL and/orthe Wnt component is CHIR99021. The effective concentration and/orcombination can be determined by monitoring and optimizing for WT1expression, basonuclin 1 (BNC1) expression, annexin A8 (ANXA8)expression and/or T-box 18 (TBX18) expression.

The term “a cardiomyocyte lineage cell” as used herein refers to a cellthat is NKX2-5+ and which can differentiate to a cardiomyocyte, forexample using a method described herein.

The term “an epicardial lineage cell” as used herein, refers to a cellthat is WT1+ and which can differentiate to an epicardial cell, forexample using a method described herein and/or an epicardial derivedcells (EPDC).

The term “culturing” as used herein includes any in vitro method ofmaintaining and/or propagating a population of cells, includingmonolayer, bead, flask, or 3D cultures, optionally where ambientconditions are controlled as in an incubator and optionally involvingpassaging of cells.

The term “epithelial-to-mesenchymal transition (EMT) cocktail” as usedherein means one or more components or a composition comprising saidcomponent(s) for inducing EMT, the one or more components including aTGFβ component such as TGFβ or a combination comprising a TGFβ componentand an FGF component such as bFGF.

The term “TGFβ component” or as used herein a component or compositioncomprising said component that promotes TGFβ signaling and includes forexample TGFβ1, TGFβ2 and/or TGFβ3.

A “KDR+ cell” as used herein means a cell exhibiting “kinase-insertdomain-containing receptor” (KDR) cell surface expression and a “KDR+cell population” means a population of cells, wherein at least 50%, atleast 60%, at least 70%, at least 80%, at least 90% or at least 95% ormore of the cells exhibit KDR cell surface expression.

The term “PDGFRα+ cell” as used herein means a cell exhibiting “plateletderived growth factor receptor a” cell surface expression and a PDGFRα+cell population means a population of cells, wherein at least 50%, atleast 60%, at least 70%, at least 80%, at least 90% or at least 95% ormore of the cells exhibit PDGFRα cell surface expression.

The term “concentration” means diluted concentration in the cell culturemedium.

As used herein the term “purified population” with respect to apopulation of cells as used herein refers to a population of cells thathas been removed and separated (e.g. isolated) from a mixed orheterogeneous population of cells and/or other components such asculture medium. In some embodiments, a purified population is asubstantially pure population of cells as compared to the heterogeneouspopulation from which the cells were isolated or enriched from.

The term “substantially pure”, with respect to a particular cellpopulation, refers to a population of cells that is at least about 65%,preferably at least about 75%, at least about 85%, more preferably atleast about 90%, and most preferably at least about 95% pure, withrespect to the cells making up a total cell population. Similarly, withregard to a “substantially pure” population of for example WT1+ cells,refers to a population of cells that contain fewer than about 30%, fewerthan about 20%, more preferably fewer than about 15%, 10%, 8%, 7%, mostpreferably fewer than about 5%, 4%, 3%, 2%, 1%, or less than 1%, ofcells that are not WT1+.

The term “subject” as used herein includes all members of the animalkingdom including mammals, and suitably refers to humans.

The terms “treat”, “treating”, “treatment”, etc., as applied to a cell,include subjecting the cell to any kind of process or condition orperforming any kind of manipulation or procedure on the cell. As appliedto a subject, the terms refer to providing medical or surgicalattention, care, or management to an individual.

The term “treatment” as used herein as applied to a subject, refers toan approach aimed at obtaining beneficial or desired results, includingclinical results and includes medical procedures and applicationsincluding for example pharmaceutical interventions, surgery,radiotherapy and naturopathic interventions as well as test treatmentsfor treating cancer. Beneficial or desired clinical results can include,but are not limited to, alleviation or amelioration of one or moresymptoms or conditions, diminishment of extent of disease, stabilized(i.e. not worsening) state of disease, preventing spread of disease,delay or slowing of disease progression, amelioration or palliation ofthe disease state, and remission (whether partial or total), whetherdetectable or undetectable. “Treatment” can also mean prolongingsurvival as compared to expected survival if not receiving treatment.

As used herein, the terms “administering,” “introducing” and“transplanting” are used interchangeably in the context of deliveringcells into a subject, by a method or route which results in at leastpartial localization of the introduced cells at a desired site.

The term “contacting” is intended to include incubating the component(s)and the cell together in vitro (e.g., adding the compound to cells inculture) and the step of contacting can be conducted in any suitablemanner. For example the cells may be treated in adherent culture, or insuspension culture, 3D culture, or where the cells are cultured onbeads, the cocktail components can be added temporally substantiallysimultaneously or sequentially (e.g. within 1 hour from an addition of afirst component). The cells can also be contacted with another agentsuch as a growth factor or other differentiation agent or environmentsto stabilize the cells, or to differentiate the cells further andinclude culturing the cells under conditions known in the art forexample for culturing the pluripotent (and/or differentiated) populationfor example as further described in the Examples.

The term “cell culture medium” (also referred to herein as a “culturemedium” or “medium”) as referred to herein is a medium for culturingcells containing nutrients that maintain cell viability and supportproliferation and optionally differentiation. The cell culture mediummay contain any of the following in an appropriate combination: salt(s),buffer(s), amino acids, glucose or other sugar(s), antibiotics, serum orserum replacement, and other components such as peptide growth factors,vitamins etc. Cell culture media ordinarily used for particular celltypes are known to those skilled in the art.

The term “pluripotent stem cell” as used herein refers to a cell withthe capacity, under different conditions, to differentiate to more thanone differentiated cell type, and for example the capacity todifferentiate to cell types characteristic of the three germ celllayers, and includes embryonic stem cells and induced pluripotent stemcells. Pluripotent cells are characterized by their ability todifferentiate to more than one cell type using, for example, a nudemouse teratoma formation assay. Pluripotency is also evidenced by theexpression of embryonic stem (ES) cell marker. As used herein,pluripotent stems can include cell lines including induced pluripotentstem cells (iPSC) and embryonic stem cells (ESC). In an embodiment, thepluripotent stem cells are not human embryonic stem cells.

As used herein, the terms “iPSC” and “induced pluripotent stem cell” areused interchangeably and refers to a pluripotent stem cell artificiallyderived (e.g., induced or by complete reversal) from a non-pluripotentcell, typically an adult somatic cell, for example, by inducingexpression of one or more genes (including POU4F1/OCT4 (Gene ID; 5460)in combination with, but not restricted to, SOX2 (Gene ID; 6657), KLF4(Gene ID; 9314), cMYC (Gene ID; 4609), NANOG (Gene ID; 79923),LIN28/LIN28A (Gene ID; 79727)).

The term “embryonic stem cell” is used to refer to the pluripotent stemcells of the inner cell mass of the embryonic blastocyst (see, forexample, U.S. Pat. Nos. 5,843,780, 6,200,806). Such cells can also beobtained from the inner cell mass of blastocysts derived from somaticcell nuclear transfer (see, for example, U.S. Pat. Nos. 5,945,577,5,994,619, 6,235,970). The distinguishing characteristics of anembryonic stem cell define an embryonic stem cell phenotype.Accordingly, a cell has the phenotype of an embryonic stem cell if itpossesses one or more of the unique characteristics of an embryonic stemcell such that that cell can be distinguished from other cells.Exemplary distinguishing embryonic stem cell characteristics include,without limitation, gene expression profile, proliferative capacity,differentiation capacity, karyotype, responsiveness to particularculture conditions, and the like.

The term “expression” refers to the cellular processes involved inproducing RNA and proteins and as appropriate, secreting proteins, andcell surface expression, including where applicable, but not limited to,for example, transcription, translation, folding, modification andprocessing. “Expression products” include RNA transcribed from a geneand polypeptides obtained by translation of mRNA transcribed from agene.

In understanding the scope of the present disclosure, the term“comprising” and its derivatives, as used herein, are intended to beopen ended terms that specify the presence of the stated features,elements, components, groups, integers, and/or steps, but do not excludethe presence of other unstated features, elements, components, groups,integers and/or steps. The foregoing also applies to words havingsimilar meanings such as the terms, “including”, “having” and theirderivatives. Finally, terms of degree such as “substantially”, “about”and “approximately” as used herein mean a reasonable amount of deviationof the modified term such that the end result is not significantlychanged. These terms of degree should be construed as including adeviation of at least ±5% of the modified term if this deviation wouldnot negate the meaning of the word it modifies.

In understanding the scope of the present disclosure, the term“consisting” and its derivatives, as used herein, are intended to beclose ended terms that specify the presence of stated features,elements, components, groups, integers, and/or steps, and also excludethe presence of other unstated features, elements, components, groups,integers and/or steps.

The recitation of numerical ranges by endpoints herein includes allnumbers and fractions subsumed within that range (e.g. 1 to 5 includes1, 1.5, 2, 2.75, 3, 3.90, 4, and 5). It is also to be understood thatall numbers and fractions thereof are presumed to be modified by theterm “about.” Further, it is to be understood that “a,” “an,” and “the”include plural referents unless the content clearly dictates otherwise.The term “about” means plus or minus 0.1 to 50%, 5-50%, or 10-40%,preferably 10-20%, more preferably 10% or 15%, of the number to whichreference is being made.

Further, the definitions and embodiments described in particularsections are intended to be applicable to other embodiments hereindescribed for which they are suitable as would be understood by a personskilled in the art. For example, in the following passages, differentaspects of the invention are defined in more detail. Each aspect sodefined may be combined with any other aspect or aspects unless clearlyindicated to the contrary. In particular, any feature indicated as beingpreferred or advantageous may be combined with any other feature orfeatures indicated as being preferred or advantageous.

II. Methods and Products

Described herein are methods for producing cardiovascular lineage cellsincluding cardiomyocyte lineage cells, epicardial lineage cells andepicardial derived cells. Components and conditions for specifying thesecell types as well as markers for monitoring emergence of these celltypes are described.

Accordingly, an aspect includes a method of obtaining a cardiovascularlineage cell population, optionally cardiomyocyte lineage cellpopulation or an epicardial lineage cell population from pluripotentstem cells (PSCs) optionally human PSCs (hPSCs) comprising the steps:(a) contacting BMP component primed hPSCs with a cardiovascular mesodermprogramming cocktail suitable for inducing the hPSCs to differentiate toa cardiovascular mesoderm cell population under conditions suitable forthe programming cocktail to penetrate the hPSCs and culturing thecontacted hPSCs for a period of time to generate a KDR+ and PDGFRα+cardiovascular mesoderm cell population; (b) contacting thecardiovascular mesoderm cell population with a cardiovascular progenitorspecification cocktail suitable to specify a NKX2-5+ or WT1+cardiovascular progenitor cell population under conditions suitable forthe specification cocktail to penetrate the cardiovascular mesoderm cellpopulation and culturing the contacted cardiovascular mesoderm cellpopulation for a period of time to generate a NKX2-5+ or WT1+cardiovascular progenitor cell population; and (c) contacting thecardiovascular progenitor cell population with a maturation cocktailunder conditions suitable for the maturation cocktail to penetrate thecardiovascular progenitor cell population and culturing the contactedcardiovascular progenitor population for a period of time to produce acardiovascular lineage population optionally cardiomyocyte lineage cellsexpressing cardiac troponin T (cTnT) and/or SIRPA and/or an epicardiallineage cell population optionally expressing WT1 and/or comprisingEPDCs.

KDR and PDGFRα can be used to monitor development of a cardiovascularmesoderm cell population. The expression of KDR can be monitored usingan antibody specific for KDR and/or the expression of PDGFRα can bemonitoring using an antibody specific for PDGFRα. As both are cellsurface expressed, KDR and PDGFRα expression can be monitored bymeasuring cell surface expression. For example, the expression of KDRand PDGFRα can be monitored using flow cytometry.

In an embodiment, the BMP component primed hPSCs are prepared bycontacting the hPSCs with BMP component for about 1 to about 2 days,optionally wherein the BMP component is BMP4 and/or BMP2.

In an embodiment, the cardiovascular mesoderm programming cocktailcomprises a BMP component and an activin component and optionally a FGFcomponent and the cardiovascular mesoderm programming cocktail iscontacted with the hPSCs for about 3 to about 5 days.

In an embodiment, the FGF component comprises bFGF.

In an embodiment, the BMP component comprises BMP4 and/or BMP2.

In an embodiment, the activin component comprises Activin A.

Concentrations of activin component and BMP component can be optimizedas described.⁵

In an embodiment, the PSCs are comprised in embryoid bodies.

Using for example steps a) and b) above, it is demonstrated herein thata NKX2-5+ or WT1+ cardiovascular progenitor cell population can beobtained.

Accordingly a further aspect includes a method for obtaining a NKX2-5+or WT1+ cardiovascular progenitor cell population from PSCs, optionallyhPSCs, comprising the steps: (a) obtaining a KDR+ and PDGFRα+cardiovascular mesoderm cell population from hPSCs optionally asdescribed above; (b) contacting the KDR+ and PDGFRα+ cardiovascularmesoderm cell population with a cardiovascular progenitor specificationcocktail under conditions suitable for the specification cocktail topenetrate the cardiovascular mesoderm cell population and culturing thecontacted cardiovascular mesoderm cell population for a period of timesufficient to generate a NKX2-5+ or WT1+ cardiovascular progenitor cellpopulation.

In an embodiment, the KDR+ and PDGFRα+ cardiovascular mesoderm cellpopulation is dissociated prior to contacting with the cardiovascularprogenitor specification cocktail.

In some embodiments, the KDR+ PDGFRα+ expressing cells are purifiedbefore contacting with the cardiovascular progenitor specificationcocktail.

In another embodiment, the cardiovascular mesoderm cell population iscontacted with the cardiovascular progenitor specification cocktail forat least 12 hours to about 48 hours, or any amount of time between 12and 48 hours.

In an embodiment, the cardiovascular progenitor specification cocktailcomprises a cardiomyocyte lineage promoting component, wherein thecardiomyocyte promoting component is in a suitable concentration forpromoting cardiomyocyte development and specifies a NKX2-5+cardiovascular progenitor population.

In an embodiment, the cardiomyocyte promoting component comprises a BMPinhibitor, for example for use with cardiovascular mesoderm cellpopulation endogenously expressing a level of BMP that inhibitscardiomyocyte specification.

In an embodiment, the cardiomyocyte promoting component comprises nogginat a concentration of less than 200 ng/mL, less than 150 ng/mL, lessthan 100 ng/mL, less than 50 ng/mL, or less than 25 ng/mL and/or greaterthan 12.5 ng/mL.

In another embodiment, the cardiomyocyte promoting component isdorsomorphin at a concentration of less than 1 μM, less than 0.5 μM,less than 0.25 μM, or less than 0.1 μM.

In another embodiment, the cardiomyocyte promoting component is BMP4 ata concentration of less than 0.63 ng/mL, less than 0.5 ng/mL, less than0.4 ng/mL, or less than 0.3 ng/mL.

In another embodiment, the cardiovascular progenitor specificationcocktail comprises: 1) a combination of a Wnt inhibitor optionallyselected from, DKK1, XAV939 and IWP2 and a BMP component, optionallywherein the BMP component is BMP4 at a concentration of at least 0.01ng/mL, at least 0.05 ng/mL, at least 0.1 ng/mL, at least 0.5 ng/mL, atleast 1.25 ng/mL, at least 2.5 ng/mL, at least 5 ng/mL, but less than 10ng/ml, or less than 15 ng/mL or preferably about 0.5 ng/mL; or 2) a BMPinhibitor, such as noggin or dorsomorphin, for example noggin at aconcentration of less than 200 ng/mL, less than 150 ng/mL, less than 100ng/mL, less than 50 ng/mL, less than 25 ng/mL or greater than 12.5ng/mL; 3) a Wnt inhibitor, for example wherein there is sufficientendogenous BMP4 produced; and/or 4) a cardiomyocyte lineageconcentration of a BMP component, optionally BMP4 for example whereinthe BMP4 is at a concentration of less than 0.63 ng/mL, less than 0.5ng/mL, less than 0.4 ng/mL, or less than 0.3 ng/mL. The effectiveconcentration and/or combination can be determined by monitoring andoptimizing for NKX2-5 expression and/or TNNT2/cTnT expression.

A Wnt inhibitor can be used without BMP to induce cardiomyocytespecification for example when the mesoderm population of cells producessufficient endogenous BMP component.

A BMP component in a concentration that promotes cardiomyocytespecification can be used for example when the mesoderm population ofcells produces insufficient endogenous BMP component.

The level of an endogenous component that is secreted, such as BMP4 orBMP2 can measured by ELISA or other quantitative immunoassays orquantitative RT-PCR.

In another embodiment, the KDR+ PDGFRα+ cardiovascular mesodermpopulation and/or the NKX2-5+ cardiovascular progenitor population ispurified/isolated.

In another embodiment, the NKX2-5+ cardiovascular progenitor cellpopulation is further contacted with a maturation cocktail optionallycomprising a VEGF component. The maturation cocktail can be culturemedium suitable for the cell type and/or include additional components.

A further aspect includes a method for producing cardiac troponin T+(cTnT) cardiomyocyte lineage cell population comprising: (a) obtaining aNKX2-5+ cardiovascular progenitor population according to the method ofany one of claims 1 to 16; (b) contacting the cardiovascular progenitorcell population with a maturation cocktail comprising a VEGF componentunder conditions suitable for the maturation cocktail to penetrate thecardiovascular progenitor cell population; and (b) culturing thecontacted cardiovascular progenitor population for a period of timesufficient to produce cardiomyocytes expressing cardiac troponin T(cTnT).

In an embodiment, the NKX2-5+ cardiovascular progenitor population iscontacted with the maturation cocktail for 4 or more days, for exampleat least about 4, optionally about 5, about 9, about 15 or about 20days, optionally until mature contracting cardiomyocytes are produced.The cells can be kept in culture to mature until the desired cellpopulation is obtained.

A further aspect is a method of producing a WT1+ epicardial lineage cellpopulation, comprising the steps: (a) obtaining a KDR+ and PDGFRα+cardiovascular mesoderm cell population from hPSCs optionally as definedabove; (b) contacting the cardiovascular mesoderm cell population with acardiovascular progenitor specification cocktail comprising anepicardial lineage promoting component under conditions suitable for thespecification cocktail to penetrate the cardiovascular mesoderm cellpopulation and culturing the contacted cardiovascular mesoderm cellpopulation for a period of time sufficient to generate a WT1+cardiovascular progenitor cell population.

In an embodiment, the cardiovascular progenitor specification cocktailcomprises an epicardial cell promoting component, optionally wherein theepicardial cell promoting component comprises BMP4 in a suitableconcentration for promoting epicardial cell development.

In another embodiment, the epicardial cell-promoting component comprisesBMP4 at a concentration of at least 1.25 ng/mL, at least 2.5 ng/mL, atleast 5 ng/mL or at least 10 ng/mL.

In another embodiment, the epicardial cell promoting component furthercomprises a Wnt component, optionally CHIR99021.

In yet another embodiment, the epicardial cell promoting componentcomprises BMP4 and a Wnt component optionally CHIR 99021.

In another embodiment, the WT1+ cardiovascular progenitor cellpopulation is contacted with a maturation cocktail comprising a VEGFcomponent.

In another embodiment, the WT1+ cardiovascular progenitor population iscontacted with the maturation cocktail for about 4 or more days,optionally about 5, about 9, about 15 or about 20 days to produce amaturation cocktail contacted WT1+ epicardial lineage cell population.

In another embodiment, the maturation cocktail contacted WT1+ epicardiallineage cell population is purified/isolated.

In another embodiment, the maturation cocktail contacted WT1+ epicardiallineage cell population is cultured to obtain a zona occludins 1(ZO1)+WT1+ epicardial lineage cell population, optionally wherein theZO1+WT1+ epicardial lineage cell population is purified/isolated.

In another embodiment, the maturation cocktail contacted WT1+ epicardiallineage cell population and/or the ZO1+ WT1+ epicardial lineage cellpopulation is contacted with an epithelial-to-mesenchymal transition(EMT) cocktail and cultured for a period of time.

In another embodiment, the EMT cocktail comprises: 1) a TGFβ component;2) a TGFβ component and a FGF component, optionally wherein the TGFβcomponent and the FGF component are sequentially administered; or 3) FGFcomponent.

In an embodiment, the TGFb component is TGFb-1. In an embodiment, theFGF component is bFGF.

As shown in Example 2, treatment of WT1+ cells EMT cocktail comprisingTGFb gives rise to functional smooth muscle cells and treatment of WT1+cells with EMT cocktail comprising TGFb and bFGF gives rise to a higherpercentage of smooth muscle cells.

In an embodiment, the WT1+ cells are contacted with EMT cocktail fromabout 1 day to up to 3 weeks, for example about 1 day, 2 days, 3 days, 4days, 5 days, 6 days, 7 days, 8 days, 9 days or about 10 days or about 1week, 2 weeks or weeks. For example where the EMT cocktail comprisescomponents that are sequentially administered, each component can beadministered for about 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 7days, 8 days, 9 days or about 10 days, or about 1 week, about 2 weeks orabout 3 weeks.

In an embodiment, the TGFb component is TGFβ-1 and the concentration isfrom about 0.25 ng/ml to about 10 ng/ml or any one 0.1 ng/ml incrementbetween 0.25 ng/ml and 10 ng/ml. Comparable concentrations of other TGFbcomponents that produce similar TGFb signaling pathway activation can beused.

In an embodiment, the FGF component is bFGF and the concentration isfrom about 1 ng/ml to about 50 ng/ml or any 1 ng/ml increment between 1ng/ml and 50 ng/ml. Comparable concentrations of other FGF componentsthat produce similar FGF signaling pathway activation can be used.

In yet another embodiment, the EMT cocktail is contacted with the WT1+population of cells according to the following schedule: 1) TGFβ-1 (forexample about 0.25 to about 10 ng/ml) for about four days followed byfour days with no additional factor (TGFβ), 2) TGFβ-1 (for example about0.25 to about 10 ng/ml) for about four days followed by about four dayswith bFGF (for example about 1 to about 50 ng/ml) (TGFβ+bFGF), or 3)bFGF (for example about 1 to about 50 ng/ml) for about eight days(bFGF).

In another embodiment, the EMT cocktail comprises: 1) TGFβ component; or2) a TGFβ component and a FGF component; and the cell population iscultured for a period of time to produce expression of an EMT markersuch as SNAI1 and/or SNAI2 (detectable for example by measuring SNAI1and/or SNAI2 transcript expression levels), a mesenchymal marker such asvimentin and/or CD90 and/or a smooth muscle marker such as SMA,optionally measured by flow cytometry or expression of a smooth musclegene optionally CNN1, MYH11, TAGLN and SMTN.

As demonstrated in Example 2, the smooth muscle-like cells generatedfollowing EMT exhibited NE and PE induced calcium transients. Theproportion of cells displaying calcium transients was highest (70%) inthe population induced by TGFβ+bFGF indicating that this combination ofsignaling pathways efficiently promoted the development of smooth musclecells capable of contraction (FIG. 16a ). In an embodiment, the cellpopulation is cultured for a period of time sufficient to produce apopulation of cells wherein at least 50%, at least 60% or at least 70%of the cells of the population display a calcium transient upon NE or PEstimulation.

In another embodiment, the population of cells is cultured until thepopulation of cells expresses a smooth muscle marker or transcript toobtain a vascular smooth muscle lineage cell population, optionallyuntil the population of cells expresses increased levels of amesenchymal marker, optionally vimentin and/or CD90.

In another embodiment, the EMT cocktail comprises: an FGF component andthe cell population is cultured to produce a fibroblast lineage cellpopulation expressing an epicardial-derived fibroblast marker optionallyTCF21, optionally measured by qRT-PCR.

It is further demonstrated in Example 2, that EMT induced hPSC-derivedEpi cells can acquire invasiveness. For example invasion was monitoredeight days following the induction of EMT and cells induced with bFGFalone were the most migratory and invaded the matrigel to the greatestdepth. bFGF treatment also led to an increase in total cell numberwithin the regions of interest (ROI; e.g. a region where the recordingtook place). Accordingly, in another embodiment, the cell population iscultured for a period of time sufficient to produce a population ofcells wherein a proportion of the cells of the population acquireinvasiveness. Invasiveness includes for example a cell that can migrateat least 100 μm, 150 μm, 200 μm, 250 μm, 300 μm, 400 μm, 500 μm or 600μm in a Matrigel assay as described in Example 2.

In an embodiment, a cell population is purified/isolated optionallyusing flow cytometry, including fluorescence-activated cell sorting(FACS), magnetic separation, affinity chromatography, immunostainingand/or resistance to cytotoxic agent. In other embodiment,purification/isolation is based on detecting non-surface expressedmarkers, which can be achieved my monitoring an aliquot for example byquantitative RT or other PCR and immuno-based assays such as westernblot.

In another embodiment, the population of cells is cultured to expressTCF21 to obtain a fibroblast lineage cell population.

In another embodiment, the maturation cocktail contacted WT1+ epicardiallineage cell population and/or the WT1+ ZO1+ epicardial lineage cellpopulation is cultured for a period of time to obtain a retinoldehydrogenase expressing epicardial lineage cell population, optionallywherein the retinol dehydrogenase expressing epicardial lineage cellpopulation is ALDH1A2 expressing or Aldefluor positive staining,optionally wherein the cell population is at least 50% Aldefluorpositive.

In another embodiment, the vascular smooth muscle lineage cellpopulation, a fibroblast lineage cell population and/or a retinoldehydrogenase expressing epicardial lineage cell population ispurified/isolated.

In another embodiment, the cardiovascular progenitor specificationcocktail further comprises an activin/nodal inhibitor, optionallySB431542. For example, SB431542 added during the cardiovascularspecification stage can promote both cardiomyocyte and epicardialspecification.

In another embodiment, the PSCs are a human PSC. In yet anotherembodiment, the PSC is an induced pluripotent stem cell (iPSC) line,optionally a human iPSC and/or an embryonic stem cell (ESC) line,optionally a human ESC (hESC). In an embodiment, the iPSC is afibroblast derived iPSC line.

A further aspect includes a purified population of cardiovascularlineage cell or cell population and/or a cell or cell populationdifferentiated therefrom produced according to the method of describedherein. For example it is demonstrated here that cardiomyocyte orepicardial lineage cells can be specified with contaminating cell types.In an embodiment, the purified population is comprised in a gel,optionally Matrigel. Accordingly, the desired population can be purifiedwith minimal intervention.

In an embodiment, the cells are adhered to a solid support such as adish or flask.

Another aspect includes a composition comprising a purified/isolatedcardiovascular lineage cell or cell population and/or a cell or cellpopulation differentiated therefrom produced according to the method ofdescribed herein; and a suitable diluent.

A suitable diluent includes for example a suitable culture medium, orfreezing medium containing for example serum, a serum substitute orserum supplement and/or a suitable cryoprotectant such as dimethylsulphoxide (DMSO), glycerol Methylcellulose or polyvinyl pyrrolidone.

Another aspect includes a culture medium supplement comprising acardiovascular progenitor specification cocktail, optionally comprisinga BMP component in a concentration for specifying cardiomyocytes orcomprising a BMP component and a Wnt component for epicardialspecification. The components can be in liquid or powder form forreconstitution.

The components can be comprised in a single supplement to be added tobase media such as Life Technologies StemPro-34. The amount of thecomponents in the supplement can for example be amounts that whendiluted in a culture medium (e.g. when diluted in a 450 mL base medium)result in concentrations described herein.

Another aspect includes a culture medium comprising the specificationcocktail optionally comprising a BMP component in a concentration forspecifying cardiomyocytes or comprising a BMP component and a Wntcomponent for epicardial specification. Typical culture mediumcomponents such as can also be included

Also included in another aspect is a kit comprising: 1) an agent formeasuring expression of a marker expressed on a cardiovascular lineagecell or cell differentiated therefrom the marker selected from KDR,PDGFRα, NKX2-5+, WT1, ZO1, EMT marker such as SNAI1 and/or SNAI2, amesenchymal marker such as vimentin and/or CD90 and/or a smooth musclemarker such as SMA, a smooth muscle gene optionally CNN1, MYH11, TAGLNand SMTN, TCF21, retinol dehydrogenase, and/or Aldefluor activity;and/or 2) a component or composition such as a culture medium comprisingsaid component for inducing differentiation of a cardiovascular lineagecell population, the components selected from cocktail optionallycomprising a BMP component in a concentration for specifyingcardiomyocytes or comprising a BMP component and a Wnt component forepicardial specification.

The agent can for example be an antibody or fragment thereof forimmuno-assays and flow based methods, primers for detecting a particulartranscript and/or a probe for detecting expression by a probe basedmethod such as RT-PCR, qRT-PCR, in situ hybridization and MilliporeSmartFlare.

The composition and kit components can include any of the componentsdescribed elsewhere herein and optionally instructions for use. Forexample, in an embodiment, the kit comprises a supplement comprisingcomponents etc. to induce differentiation of one or more stages orlineages described herein (e.g. including components described in theExamples). In an embodiment, the kit comprises a base culture medium,optionally a base culture medium described herein and a culture mediumsupplement described herein.

The cells produced according to a method described herein can be used toscreen for agents that promote and/or inhibit cardiovascular lineagecell differentiation.

Accordingly a further aspect includes a method for identifying acardiovascular cell differentiation promotion agent comprising thesteps: (a) contacting a test cell population with a test agent at a stepin a method described herein; (b) monitoring for expression of a markerselected from KDR, PDGFRalpha, NKX2-5+, WT1, ZO1, a mesenchymal markersuch as vimentin and/or CD90 and/or a smooth muscle marker such as SMA,a smooth muscle gene optionally CNN1, MYH11, TAGLN and SMTN, TCF21,retinol dehydrogenase, and/or Aldefluor activity levels in the test cellpopulation and a control; and (c) identifying the test agent as acardiovascular cell differentiating promotion agent when the test agentinduces and/or increases expression of the cardiovascular marker and/orinduces specification of cardiomyocyte, epicardial or EPDC.

For example, co-culture assays can be performed in which hPSC-derivedepicardium and cardiomyocytes can be mixed and plated either inaggregate or monolayer format. After a pre-determined amount of time,cultures may be assayed by qRT-PCR, flow cytometry, or immuno-basedmethods for changes in gene and protein expression. Cultures can beassessed for example for sarcomere morphology by staining for alphaactinin, atrial natriuretic factor (ANF), and/or brain natriureticpeptide (BNP); mitochondrial maturity which can for example be assessedusing flow cytometry and/or immunological methods; myosin regulatorylight chain 7 (MYL7) which is predominantly expressed in adult atrialmuscle and/or WT1 downregulation (e.g. indicative of epicardialmaturity). Examples of flow cytometry and immunological methods areprovided in the Examples.

In an embodiment, the method is used for drug screening of acardiovascular drug, for example for promoting and/or interfering withcardiac and/or vascular remodeling.

In an embodiment, HPSC derived cardiomyocyte and epicardial lineagecells and/or tissue produced using a method described herein are 1)co-cultured, optionally in combination with endothelial cells; 2)contacted with a test agent; and 3) assessed for i) cell death or ii)increased proliferation, optionally in endothelial cell numbers; and/oriii) altered tissue organization, compared to a control, wherein adecrease in cell death, an increase in proliferation one or more of thecell lineages and/or I) decreased or II) increased cellular organizationcompared to the control is indicative that the test agent is a putativecardiovascular drug. Endothelial cell numbers can for example beassessed by staining for CD31; cell death and/or proliferation can beassessed for example by flow cytometry, cell counting methods and/orflow cytometry; and cellular organization be assessed visually.

In an embodiment, the method is for identifying putative agents forpromoting epicardium differentiation, replacement of scar tissue,revascularization of ischemic areas etc. In an embodiment, HPSC derivedcardiomyocyte and epicardial lineage cells and/or tissue produced usinga method described herein are 1) co-cultured, optionally in combinationwith endothelial cells; 2) contacted with a test agent under hypoxic orother cardiotoxic conditions; and 3) assessed for i) cell death or ii)increased proliferation, optionally in endothelial cell numbers; and/oriii) altered tissue organization under hypoxic conditions, compared to acontrol, wherein a decrease in cell death, an increase in proliferationone or more of the cell lineages and/or I) decreased or II) increasedcellular organization compared to the control is indicative that thetest agent is a putative agent for promoting epicardium differentiation,replacement of scar tissue, revascularization of ischemic areas.Endothelial cell numbers can for example be assessed by staining forCD31; cell death and/or proliferation can be assessed for example byflow cytometry, cell counting methods and/or flow cytometry; andcellular organization be assessed visually.

Myocardial infarction can also be induced a variety of model organismsand hPSC-derived epicardial cells can be transplanted to the outer layof the heart. Heart function recovery, myocyte proliferation/survival,and the contribution of EPDCs can be assayed.

Accordingly a further aspect includes a method of introducing acardiovascular population of cells into a subject in need thereof,comprising producing a population of cells according to a methoddescribed herein, purifying the cell population and administering saidpopulation of cells into the subject in need thereof.

The population of cells is optionally comprised is an isotoniccomposition suitable for administration to a subject.

A further aspect includes a method of treating a subject in needthereof, comprising transplanting to the subject a population of cellsproduced according to a method described herein, optionally a purifiedcell population.

In an embodiment, the subject has suffered or is suffering a transientischemic attack. In an embodiment, the subject has ischemic heartdiseases.

In an embodiment the subject is administered a population produced fromhPSCs, wherein the hPSCs are autologous iPSCs.

A number of genes and gene products are described herein. All referenceaccession numbers for genes and gene products referred to, includingTNNT2—NM_001276345.1, NKX2-5—NM_004387.3, WT1—NM_024426.4,TBX18—NM_001080508.2, GATA4—NM_002052.3, GATA5—NM_080473.4,ISL1—NM_002202.2, TBX5—NM_000192.3, BNC1—NM_001717.3,ANXA8—NM_001271702.1, SNAI1—NM_005985.3, SNAI2—NM_003068.4,CCN1—NM_001299.4, MYH11—NM_001040113.1, TAGLN—NM_001001522.1,SMTN—NM_001207017.1, TCF21—NM_198392.2, ALDH1A1—NM_000689.4,ALDH1A2—NM_003888.3, and ALDH1A3—NM_000693.2, the sequences associatedtherewith are herein incorporated by reference in their entirely.

The above disclosure generally describes the present application. A morecomplete understanding can be obtained by reference to the followingspecific examples. These examples are described solely for the purposeof illustration and are not intended to limit the scope of theapplication. Changes in form and substitution of equivalents arecontemplated as circumstances might suggest or render expedient.Although specific terms have been employed herein, such terms areintended in a descriptive sense and not for purposes of limitation.

The following non-limiting examples are illustrative of the presentdisclosure:

EXAMPLES Example 1

Media consisting of StemPro-34 (Life Technologies) supplemented with 10ng/ml penicillin/streptomycin, 2 mM L-glutamine, 1 mM ascorbic acid, and4 3 10_4 M monothioglycerol (MTG) (Sigma). Human-BMP4, human-bFGF,human-Activin A, human-DKK1, and human-VEGF (R&D Systems) were added atthe indicated time points and concentrations. The Activin/Nodal/TGF-band BMP inhibition experiments were carried out with SB-431542 (Tocris,Ellisville, Mo.) and dorsomorphin (Sigma), respectively. For experimentsinvolving Wnt signaling, CHIR-99021 (Stemgent), XAV-939 (R&D), orIWP2(R&D) were used at the indicated concentrations. Cultures weremaintained in a 5% CO2, 5% O2, 90% N2 environment for the first 10-12days and were then transferred into a 5% CO2 air environment for theremainder of the culture period. At indicated time points, cells wereharvested and analyzed by flow cytometry or cell sorted.

Results

Cardiomyocyte Specification.

The development of the cardiovascular lineages from hPSCs progressesthrough at least three distinct steps, the induction of KDR⁺PDGFR⁺cardiovascular mesoderm and the specification of this mesoderm to acardiovascular fate resulting in the development of NKX2-5⁺cardiovascular progenitors and subsequently the maturation tocontracting cardiomyocytes (FIG. 1). While activin A and BMP4 are thekey regulators of the first stage⁵ pathways controlling cardiacspecification are less well understood and likely to differ from theinduction step. To investigate the specification step, a model wasestablished that enabled us to easily manipulate signaling pathwaysduring this stage of development (FIG. 1). With this approach,cardiovascular mesoderm is induced in EBs with optimal concentrations ofactivin and BMP4 as described⁵. At day 4 of mesoderm induction, the EBsare dissociated, the cells plated in monolayer in microtitre wells(1×10⁵ per well) and treated with different pathway agonists andantagonists for 24-48 hours. Following this specification step, thecultures are maintained in the presence of VEGF and analyzed at day 15for the presence of contracting cells that express cardiac troponin T(cTnT) and/or SIRPA. Initial studies showed that cardiomyocytesroutinely develop in the presence of the Wnt inhibitor DKK1 and theactivin/nodal/TGFβ inhibitor SB431542 indicating that these pathways arenot required for specification. BMP signaling, on the other hand, had aprofound effect at this stage, as addition of high levels of BMP4 or theinhibitors noggin or dorsomorphin completely blocked cardiomyocytedevelopment (FIG. 2a ). Neither manipulation dramatically impactedmesoderm development, although noggin did decrease the levels of KDR tosome extent. Inhibition of cardiomyocyte development was not due todramatic cell death as cell numbers in each group following the 48-hourtreatment were not significantly different (FIG. 2b ).

C.2. Generation of Epicardial Cells.

Titration of the agonist and antagonist during this specification steprevealed that cardiomyocyte development requires low levels of BMPsignaling, achieved by endogenous levels (produced by thedifferentiating cells) or through the addition of low levels of noggin(12.5-200 ng/ml) or low levels of BMP4 (0.31 ng/ml) (FIG. 3). Highconcentrations of noggin, as well as the addition of BMP4 atconcentrations of 0.63 ng/ml or more, inhibited cardiomyocytespecification. As cell numbers in all groups were comparable (FIG. 2b ),these observations suggest that other lineages are generated in theabsence of signaling or in the presence of higher levels of signaling.As a first approach to identify these cells, we analyzed them forexpression of a panel of myocardial and epicardial genes over a 6-15 daytime course. As expected, genes indicative of cardiomyocyte development,including TNNT2 and NKX2-5 were only expressed in the control cultures(FIG. 4). Interestingly, two epicardial markers, WT1 and TBX18 wereexpressed exclusively (WT1) or predominantly (TBX18) in the cellsgenerated from the BMP4 treated mesoderm, raising the possibility thatthey represent the developing epicardial lineage. Recently identifiedepicardial markers BNC1 and ANXA8²² were also highly expressed in theBMP4-treated cells. Expression of other cardiac lineage markersincluding GATA4, GATA5, ISL1, and TBX5 were expressed, to some degree,in both the control and BMP4 treated cultures. The Noggin treatedcultures did not express significant levels of any of these genes.Immunostaining revealed that WT1 (nuclear) was detected only in cellsinduced with BMP4, whereas cTnT was only present in cells of thenon-treated group (FIG. 5), confirming the RT-qPCR analyses (FIG. 4). Invivo, the epicardial cells form an epithelial layer that surrounds thedeveloping heart¹⁸. In addition to their distinct morphology, epithelialcells in culture are characterized by their ability to form tightjunctions that can be monitored by the presence of the zona occludins 1(ZO1) protein. At D15 of culture the WT1-expressing cultures did notshow typical epithelial morphology and ZO1 expression was not observed(FIG. 6a ). However, following passage and culture in a larger format(from a 96-well to a 6-well plate) for 4 days, WT1⁺ cells expanded togenerate a confluent monolayer with an epithelial morphology (FIG. 6b ).Collectively, these observations strongly suggest that the BMP4-treatedcells represent hPSC-derived epicardial (Epi) cells. In Zebrafish theBMP pathway has been observed to be essential for development of thePEO²³.

To further characterize the WT1⁺ Epi cells, both the day 15 and thepassaged populations were analysed for expression of various surfaceantigens by flow cytometry. The expression patterns of these populationswere compared to that of day15 cardiomyocytes (FIG. 7). Thecardiomyocytes and both WT1-expressing Epi populations stained positivefor podoplanin (PDPN), a transmembrane glycoprotein found on developingmouse cardiomyocytes and on adult mouse epicardium^(22, 24) and thoughtto be associated with cell migration. Interestingly, both Epipopulations were also positive for SIRPα, a receptor previously shown tobe expressed on hPSC-derived and fetal cardiomyocytes⁸. The WT1⁺ Epipopulations did express the mesenchymal/fibroblast marker CD90, althoughthe levels were downregulated with passage. Consistent with our previousfindings, cardiomyocytes did not express CD90⁶. PDGFRβ, expressed onembryonic epicardium in the mouse, was detected at low levels in bothEpi populations²⁵. In contrast, the mesoderm progenitor marker PDGFRαwas not expressed on any of the populations, indicating that it isdownregulated with lineage specification. The pan-epithelial markerEPCAM was present on the cardiomyocytes but not on either of the Epipopulations. EPCAM expression is not reported as being expressed in theepicardium, most likely due to its simple squamous morpholohu^(26, 27).None of the populations expressed CD31, VE-Cadherin or cKIT indicatingthe lack of contaminating endothelial and hematopoietic cell types.Collectively, the findings from these flow cytometric analyses suggestthat the Epi cells generated from mesoderm treatment with BMPphenotypically resemble the epicardium in the mouse.

To demonstrate that the putative Epi cells are mesodermal origin, thePDGFRα⁺ (mesoderm) and PDGFRα⁻ (non-mesoderm) fractions from the day 4populations were isolated and analyzed. As shown in FIG. 8, thecardiomyocytes (FIG. 7b ) and the WT1⁺TBX18⁺ Epi cells (FIG. 7c,d ) weregenerated only from the positive population indicating that they are ofmesodermal origin. These observations represent the first demonstrationthat it is possible to generate epicardial cells from human pluripotentstem cells.

The findings that BMP4 can specify the cardiomyocyte and WT1⁺epicardial-like lineages in the presence of Wnt and activin/nodalinhibitors suggests that these pathways do not play a role at this stageof cardiovascular development. This interpretation, is not however, inline with the observations that the hearts of Dkk1^(−/−)Dkk2^(−/−) nullmice have an increased thickness of the epicardium and a decrease in thesize of the myocardium compared to wild type littermates, suggestingthat Wnt signaling does, in fact, play some role in the development ofthis lineage²⁸. To reconcile these differences, Wnt signaling wasfurther manipulated during stage 2, specifically focusing on inhibitionof the pathway by titration of DKK1 or the small molecule antagonistsXAV939 or IWP2 in the presence of either BMP4, the small moleculeinhibitor of BMP dorsomorphin²⁹ (DM, in place of noggin) or no BMPpathway regulators control (no treatment). As shown in FIG. 9a ,increasing amounts of DKK1 did alter the fate of the BMP4-treatedcultures and promoted the development of cardiomyocytes rather than theWT1⁺ Epi population. The addition of XAV939 or IWP2 had similar effectsto that of high concentrations of DKK1 (FIGS. 9c and d ). Thecardiomyocyte potential of the DM-treated and non-BMP cultures werelargely unaffected by these manipulations (FIGS. 9a, c and d ). Asexpected, activation of the Wnt pathway by the addition of the smallmolecule Wnt agonist CHIR99021 (CHIR) inhibited cardiomyocytedevelopment in the endogenous BMP control while DM-treated cultures wereunaffected by CHIR addition (FIG. 9a ).

Expression analysis showed that addition of higher concentrations ofDKK1 or the small molecule antagonists XAV939 and IWP2 decreased WT1expression in BMP4-treated cells indicating a loss of the epicardialpopulation and instead specification of the cardiomyocyte lineage (FIG.9b-d ). Activation of the Wnt pathway by CHIR did not impact WT1expression in BMP4-treated cells but did result in increased levels inthe endogenous BMP population whereas DM treated cultures showed nochange in WT1 expression (FIG. 9b ). Taken together, these observationsdemonstrate that Wnt signaling is required for the specification of theepicardial lineage.

For all remaining studies, cardiomyocytes were generated by the additionof BMP4 and XAV939 to the D4 mesoderm whereas the combination of BMP4and CHIR was used to induce the WT1⁺ epicardial lineage. Cells treatedwith the BMP inhibitor DM were used as the non-cardiomyocyte,non-epicardium control population. Using this protocol it was possibleto generate WT1⁺ epicardial-like cells from other hPSC lines including ahuman fibroblast-derived iPSC line (Sendai hiPSC) and the hESC line H7(FIGS. 10a and b ).

To determine if the hESC-derived WT1⁺ epicardial-like cells can undergoEMT, an assay was designed in which D15 epicardial cells are passaged,allowed one day to recover, and then treated for a total of eight dayswith one of four treatment regimens. The regimens consisted of: 1)TGFβ-1 for four days followed by four days with no additional factor(TGFβ), 2) TGFβ-1 for four days followed by four days with bFGF(TGFβ+bFGF), 3) bFGF for eight days (bFGF) or 4) no additional factorsfor eight days (FIG. 11a ). Following culture under the differentconditions, the cells were harvested and analyzed by qRT-PCR and flowcytometry.

Expression levels of WT1 were downregulated immediately followingpassage and then gradually upregulated over the eight-day culture period(FIG. 11c ). Cells treated with either TGFβ or TGFβ+bFGF showed steadydecreases in WT1 expression over time, indicating a loss of epicardialidentity (FIG. 11c ). In contrast, the levels of WT1 expression did notdecline below those of the control in the bFGF treated cells. Expressionof the EMT markers SNAI1 and SNAI2 was also increased in the treatedpopulations, although the levels varied depending on the cytokinecombination. TGFβ, TGFβ+bFGF and bFGF all led to increases in SNAI2expression while only bFGF induced the expression of SNAI1 (FIG. 11c ).Immunostaining analyses illustrated that ZO1 expression was internalizedor lost following TGFβ or bFGF treatment (FIG. 12). Expression of WT1 byimmunostaining was consistent with transcript expression determined byqRT-PCR. The most significant loss of WT1 and ZO1 expression wasobserved in TGFβ+bFGF treated cells, although they wereindistinguishable morphologically from those treated with only TGFβ.Flow cytometric analyses showed that cells in all treated groups hadupregulated the mesenchymal marker CD90 compared to the untreatedcontrol (FIG. 11b ), supporting the interpretation that TGFβ and bFGFhad initiated EMT. Taken together, these findings indicate that the WT1⁺cells can undergo EMT following activation of the TGFβ and bFGF pathwaysand as such provide further evidence that they represent the in vitroequivalent of the developing epicardium.

To identify the cell types being specified for during EMT induction, thederivative populations were analyzed for expression of the mesenchymalmarker vimentin (VIM) and the smooth muscle marker α-smooth muscle actin(SMA) by immunostaining and for transcripts of the smooth muscle genesCNN1, MYH11, TAGLN and SMTN³⁰ and the epicardial-derived fibroblastmarker TCF21³¹ by qRT-PCR. While VIM was expressed to some degree in allpopulations, substantially brighter staining was observed in TGFβ andTGFβ+bFGF treated cells than in those treated with bFGF alone (FIG. 13).SMA was also detected at higher levels in the TGFβ and TGFβ+bFGF treatedcells compared to those cultured with bFGF or in the absence of factors.These patterns suggest that cells treated with either TGFβ or TGFβ+bFGFare progressing along the vascular smooth muscle lineage. In support ofthis is the observation that cells treated with either TGFβ or TGFβ+bFGFupregulated expression of CNN1, MYH11, TAGLN and SMTN but not TCF21(FIG. 14). In contrast, the bFGF induced population expressed TCF21 inaddition to CNN1, TAGLN and SMTN (FIG. 14). These cells, however, didnot express MYH11. Collectively, these findings indicate that TGFβspecifies hESC-derived WT1⁺ epicardial cells towards a smoothmuscle-like fate whereas bFGF promotes the development offibroblast-like cells. bFGF treatment following TGFβ appeared to enhancethe smooth muscle-like fate as observed by the increased expression ofCNN1, MYH11, TAGLN and SMTN in these cells.

To test the contractile function of the smooth muscle-like cellsgenerated following the EMT induced with TGFβ and TGFβ+bFGF, calciumtransients were measured following stimulation with norepinephrine (NE)and phenylephrine (PE) using previously described methods³². Theproportion of cells displaying calcium transients was highest (70%) inthe population induced by TGFβ+bFGF indicating that this combination ofsignaling pathways efficiently promoted the development of smooth musclecells capable of contraction (FIG. 15a ). Of the cells that exhibitedcalcium transients, similar rates of cycling were observed in the TGFβand TGFβ+bFGF induced cells following PE stimulation. Cells from bothpopulations exhibited faster calcium cycling rates than those in thenon-induced control cultures (FIG. 15b ). The amplitude of calciumresponse was greatest in PE-treated TGFβ cells compared to controlcultures (FIG. 15c ). Finally, the duration of calcium transientsfollowing PE-treatment were significantly longer in the TGFB+bFGFinduced cells than in those treated with TGFβ or those in the controlpopulation (FIG. 15d ). Taken together these findings demonstrate thatinduction of the Epi cells with the combination of TGFβ+bFGF (or TGFb toa lesser extent) promotes the development of smooth muscle cells capableof responding to agonists that result in increased calcium handling thatmay facilitate smooth muscle action potentials and contractility.

It is well established that during heart development EPDCs, and inparticular cardiac fibroblasts, invade the myocardial layer³³. To assessthis potential of the hPSC-derived Epi cells, their ability to invade a3D layer of Matrigel following induction of EMT with the differentfactors was measured. To enable us to easily track the migration of thecells, the Epi population was generated from GFP expressing hESCs⁴⁸.Matrigel invasion was monitored eight days following the induction ofEMT by confocal microscopy and evaluated using 3D image reconstruction(FIG. 16a ). The cells induced with bFGF alone were the most migratoryand invaded the matrigel to the greatest depth (FIG. 16b ), supportingthe interpretation that they are fibroblastic in nature. Along withinvasion, bFGF treatment also led to an increase in total cell numberwithin the regions of interest (ROI). None of the other groups showedthis expansion (no treatment, 73.8±6.1 cells per ROI; TGFβ, 56.8±9.5cells per ROI; bFGF, 379.7±40.5 cells per ROI, p=0.0017; TGFβ+bFGF,80.3±17.1 cells per ROI). Notably, the population induced with TGFβalone showed little capacity to invade the Matrigel, even less than thenon-treated control that may contain some cells that have undergonespontaneous EMT to the fibroblast lineage (white arrow heads). Cellsinduced with the combination of TGFβ+bFGF behaved similarly to thecontrol population and were considerably less invasive than thoseinduced with BFGF alone. To further quantify the degree of invasion, theproportion of cells in each population that migrated to different depthswas calculated. Virtually all of the cells in the non-induced, theTGFβ-induced and TGFβ+bFGF-induced populations were detected within thefirst 200 μm of the gel. In contrast, approximately half of the cells inthe bFGF-induced population migrated beyond this depth, some as far as600 μm. Collectively, these findings demonstrate that the bFGF-inducedpopulation displays migratory behavior consistent with that predictedfor EPDC in vivo. The observation that the cells with smooth musclecharacteristics do not show this potential suggests that the maturationof this lineage likely occurs following migration into the tissue.

It is well accepted that the epicardium produces retinoic acid duringdevelopment and following cardiac injury through the upregulation of theretinol dehydrogenase ALDH1A2. At D15 of differentiation the WT1⁺epicardial cells did not express ALDH1A2 (FIG. 15a ), nor did they stainpositive for Aldefluor by flow cytometry, a marker of aldehydedehydrogenase activity (FIG. 15c ). Following passage, however, thepopulation showed steady increases in ALDH1A2 expression (FIGS. 15a andb ). The retinol dehydrogenases ALDH1A1 and ALDH1A3, also involved inthe synthesis of retinoic acid but not associated with the epicardium,were expressed only at low levels (FIG. 15a ). Eight days followingpassage, the epicardial-like population had substantially upregulatedaldehyde dehydrogenase activity as measured by Aldefluor staining wheregreater than 78% of the cells were positive (FIG. 15d ). Cultures inwhich EMT had been induced with TGFβ, bFGF or TGFβ+bFGF showeddramatically lower levels of ALDH1A2 expression and Aldefluor staining,consistent with the interpretation that they are no longer epicardialcells (FIG. 15b ).

Taken together, these studies show that passaged WT1⁺ epicardial cellshave the ability to undergo EMT towards smooth muscle-like andfibroblast-like cells in response to TGF and bFGF signaling. In theabsence of an EMT-inducing signal, WT⁺ cells acquire an epithelial-likemorphology and aldehyde dehydrogenase activity through the upregulationof ALDH1A2, indicating their ability to synthesize RA (FIG. 18).

While the present application has been described with reference to whatare presently considered to be the preferred examples, it is to beunderstood that the application is not limited to the disclosedexamples. To the contrary, the application is intended to cover variousmodifications and equivalent arrangements included within the spirit andscope of the appended claims.

All publications, patents and patent applications are hereinincorporated by reference in their entirety to the same extent as ifeach individual publication, patent or patent application wasspecifically and individually indicated to be incorporated by referencein its entirety. Specifically, the sequences associated with eachaccession numbers provided herein including for example accessionnumbers and/or biomarker sequences (e.g. protein and/or nucleic acid)provided in the Tables or elsewhere, are incorporated by reference inits entirely.

CITATIONS FOR REFERENCES REFERRED TO IN THE SPECIFICATION

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1. A method of obtaining a cardiomyocyte lineage or an epicardiallineage cell population from human pluripotent stem cells (hPSCs)comprising the steps: (a) contacting BMP component primed hPSCs with acardiovascular mesoderm programming cocktail suitable for inducing thehPSCs to differentiate to a cardiovascular mesoderm cell populationunder conditions suitable for the programming cocktail to penetrate thehPSCs and culturing the contacted hPSCs for a period of time to generatea KDR+ and PDGFRalpha+ cardiovascular mesoderm cell population; (b)contacting the cardiovascular mesoderm cell population with acardiovascular progenitor specification cocktail suitable to specify aNKX2-5+ or WT1+ cardiovascular progenitor cell population underconditions suitable for the specification cocktail to penetrate thecardiovascular mesoderm cell population and culturing the contactedcardiovascular mesoderm cell population for a period of time to generatea NKX2-5+ or WT1+ cardiovascular progenitor cell population; and (d)contacting the cardiovascular progenitor cell population with amaturation cocktail under conditions suitable for the maturationcocktail to penetrate the cardiovascular progenitor cell population andculturing the contacted cardiovascular progenitor population for aperiod of time to produce a cardiovascular population, optionallycardiomyocyte lineage cells expressing cardiac troponin T (cTnT) and/orSIRPA and/or epicardial lineage cells expressing WT1.
 2. The method ofclaim 1 wherein the BMP component primed hPSCs are prepared bycontacting the hPSCs with BMP component for about 1 to about 2 days,optionally wherein the BMP component is BMP4 and/or BMP2.
 3. The methodof claim 1 or 2, wherein the cardiovascular mesoderm programmingcocktail comprises a BMP component and an activin component andoptionally a FGF component and the cardiovascular mesoderm programmingcocktail is contacted with the hPSCs for about 3 to about 5 days.
 4. Themethod of claim 3, wherein the FGF component is bFGF.
 5. The method ofclaim 3 wherein the BMP component is BMP4.
 6. The method of claim 3,wherein the activin component is Activin A.
 7. The method of any one ofclaims 1 to 6, wherein the hPSCs are comprised in embryoid bodies.
 8. Amethod for obtaining a NKX2-5+ or WT1+ cardiovascular progenitor cellpopulation from hPSCs comprising the steps: (a) obtaining a KDR+ andPDGFRalpha+ cardiovascular mesoderm cell population from hPSCsoptionally as defined in step a of claim 1; (b) contacting the KDR+ andPDGFRalpha+ cardiovascular mesoderm cell population with acardiovascular progenitor specification cocktail under conditionssuitable for the specification cocktail to penetrate the cardiovascularmesoderm cell population and culturing the contacted cardiovascularmesoderm cell population for a period of time sufficient to generate aNKX2-5+ or WT1+ cardiovascular progenitor cell population.
 9. The methodof any one of claims 1 to 8, wherein the KDR+ and PDGFRalpha+cardiovascular mesoderm cell population is dissociated prior tocontacting with the cardiovascular progenitor specification cocktail.10. The method of any one of claims 1 to 9, wherein the cardiovascularmesoderm cell population is contacted with the cardiovascular progenitorspecification cocktail for at least 12 hours to about 48 hours.
 11. Themethod of any one of claims 1 to 10, wherein the cardiovascularprogenitor specification cocktail comprises a cardiomyocyte lineagepromoting component, wherein the cardiomyocyte promoting component is ina suitable concentration for promoting cardiomyocyte development andspecifies a NKX2-5+ cardiovascular progenitor population.
 12. The methodof claim 11, wherein the cardiomyocyte promoting component is noggin ata concentration of less than 200 ng/mL, less than 150 ng/mL, less than100 ng/mL, less than 50 ng/mL, or less than 25 ng/mL and/or greater than12.5 ng/mL.
 13. The method of claim 11, wherein the cardiomyoctyepromoting component is dorsomorphin less than 1 μM, less than 0.5 μM,less than 0.25 μM, or less than 0.1 μM.
 14. The method of claim 11,wherein the cardiomyocyte promoting component is BMP4 at a concentrationof less than 0.63, less than 0.5 ng/mL, less than 0.4 ng/mL, or lessthan 0.3 ng/mL.
 15. The method of claim 11, wherein the cardiovascularprogenitor specification cocktail comprises: 1) a combination of a Wntinhibitor optionally selected from, DKK1, XAV939 and IWP2 and a BMPcomponent, optionally wherein the BMP component is BMP4 at aconcentration of at least 0.01 ng/mL, at least 0.05 ng/mL, at least 0.1ng/mL, at least 0.5 ng/mL, at least 1.25 ng/mL, at least 2.5 ng/mL, atleast 5 ng/mL, but less than 10 ng/ml, or less than 15 ng/mL orpreferably about 0.5 ng/mL; or 2) a BMP inhibitor, such as noggin ordorsomorphin, optionally noggin at a concentration of less than 200ng/mL, less than 150 ng/mL, less than 100 ng/mL, less than 50 ng/mL, orless than 25 ng/mL and/or greater than 12.5 ng/mL; 3) a Wnt inhibitor,and/or 4) a cardiomyocyte lineage concentration of a BMP component,optionally BMP4 for example wherein the BMP4 is at a concentration ofless than 0.63 ng/mL, less than 0.5 ng/mL, less than 0.4 ng/mL, or lessthan 0.3 ng/mL.
 16. The method of any one of claims 1 to 15, wherein theKDR+ PDGFRα+ cardiovascular mesoderm population and/or the NKX2-5+cardiovascular progenitor population is isolated.
 17. The method of anyone of claims 1 to 16, wherein the NKX2-5+ cardiovascular progenitorcell population is further contacted with a maturation cocktailcomprising a VEGF component.
 18. A method for producing cardiac troponinT+ (cTnT) cardiomyocyte lineage cell population comprising: (a)obtaining a NKX2-5+ cardiovascular progenitor population according tothe method of any one of claims 1 to 16; (b) contacting thecardiovascular progenitor cell population with a maturation cocktailcomprising a VEGF component under conditions suitable for the maturationcocktail to penetrate the cardiovascular progenitor cell population; and(b) culturing the contacted cardiovascular progenitor population for aperiod of time sufficient to produce cardiomyocytes expressing cardiactroponin T (cTnT).
 19. The method of claim 18, wherein the NKX2-5+cardiovascular progenitor population is contacted with the maturationcocktail for about 4 or more days, optionally about 4, about 5, about 9,about 15 or about 20 days, optionally until mature contractingcardiomyocytes are produced.
 20. A method of producing a WT1+ epicardiallineage cell population, comprising the steps: (a) obtaining a KDR+ andPDGFRalpha+ cardiovascular mesoderm cell population from hPSCsoptionally as defined in step a of claim 1; (b) contacting thecardiovascular mesoderm cell population with a cardiovascular progenitorspecification cocktail comprising an epicardial lineage promotingcomponent under conditions suitable for the specification cocktail topenetrate the cardiovascular mesoderm cell population and culturing thecontacted cardiovascular mesoderm cell population for a period of timesufficient to generate a WT1+ cardiovascular progenitor cell population.21. The method of any one of claim 1 to 10 or 20, wherein thecardiovascular progenitor specification cocktail comprises an epicardialcell promoting component, optionally wherein the epicardial cellpromoting component comprises BMP4 in a suitable concentration forpromoting epicardial cell development.
 22. The method of claim 20 or 21,wherein the epicardial cell promoting component comprises BMP4 at aconcentration of at least 1.25 ng/mL, at least 2.5 ng/mL, at least 5ng/mL or at least 10 ng/mL.
 23. The method of claim 21 or 22, whereinthe epicardial cell promoting component further comprises a Wntcomponent, optionally CHIR99021.
 24. The method of claim 20, wherein theepicardial cell promoting component comprises BMP4 and a Wnt componentoptionally CHIR
 99021. 25. The method of any one of claims 1 to 10, 20to 24, wherein the WT1+ cardiovascular progenitor cell population iscontacted with a maturation cocktail comprising a VEGF component. 26.The method of claim 25, wherein the WT1+ cardiovascular progenitorpopulation is contacted with the maturation cocktail for 4 or more days,optionally about 4, about 5, about 9, about 15 or about 20 days toproduce a maturation cocktail contacted WT1+ epicardial lineage cellpopulation.
 27. The method of claim 26, wherein the maturation cocktailcontacted WT1+ epicardial lineage cell population is isolated.
 28. Themethod of claim 25 or 26, wherein the maturation cocktail contacted WT1+epicardial lineage cell population is cultured to obtain a zonaoccludins 1 (ZO1)+ WT1+ epicardial lineage cell population, optionallywherein the ZO1+ WT1+ epicardial lineage cell population is isolated.29. The method of any one of claims 26 to 28, wherein the maturationcocktail contacted WT1+ epicardial lineage cell population and/or theZO1+ WT1+ epicardial lineage cell population is contacted with anepithelial-to-mesenchymal transition (EMT) cocktail and cultured for aperiod of time.
 30. The method of claim 29, wherein the EMT cocktailcomprises: 1) a TGFβ component; 2) a TGFβ component and a FGF component,optionally wherein the TGFβ component and the FGF component aresequentially administered; or 3) FGF component.
 31. The method of anyone of claims claim wherein the EMT cocktail is contacted with the WT1+population of cells according to the following schedule: 1) TGFβ-1 forabout four days followed by about four days with no additional factor(TGFβ), 2) TGFβ-1 for about four days followed by about four days withbFGF (TGFβ+bFGF), or 3) bFGF for about eight days (bFGF).
 32. The methodof any one of claims 29 to 31, wherein the EMT cocktail comprises: 1)TGFβ component; or 2) a TGFβ component and a FGF component; and the cellpopulation is cultured for a period of time to produce expression of anEMT marker such as SNAI1 or SNAI2, a mesenchymal marker such as vimentinand/or CD90 and/or a smooth muscle marker such as SMA, optionallymeasured by flow cytometry or expression of a smooth muscle geneoptionally CNN1, MYH11, TAGLN and SMTN.
 33. The method of any one ofclaims 29 to 32, wherein the population of cells is cultured until thepopulation of cells expresses a smooth muscle marker or transcript toobtain a vascular smooth muscle lineage cell population, optionallyuntil the population of cells expresses increased levels of amesenchymal marker, optionally vimentin and/or CD90 or until aproportion of cells exhibit calcium transients upon stimulation.
 34. Themethod of claim 29 or 30 wherein the EMT cocktail comprises: an FGFcomponent and the cell population is cultured for a period of time toproduce a fibroblast lineage cell population expressing anepicardial-derived fibroblast marker optionally TCF21, optionallymeasured by qRT-PCR.
 35. The method of claim 34, wherein the populationof cells is cultured to express TCF21 and/or attain invasiveness toobtain a fibroblast lineage cell population.
 36. The method of any oneof claims 1-10, and 26 to 28, wherein the maturation cocktail contactedWT1+ epicardial lineage cell population and/or the WT1+ ZO1+ epicardiallineage cell population is cultured for a period of time to obtain aretinol dehydrogenase expressing epicardial lineage cell population,optionally wherein the retinol dehydrogenase expressing epicardiallineage cell population is ALDH1A2 expressing or Aldefluor positivestaining, optionally wherein the cell population is at least 50%Aldefluor™ positive.
 37. The method of any one of claims 33 to 36,wherein the vascular smooth muscle lineage cell population, a fibroblastlineage cell population and/or a retinol dehydrogenase expressingepicardial lineage cell population are isolated.
 38. The method of anyone of claims 1 to 37, wherein cardiovascular progenitor specificationcocktail further comprises an activin/nodal inhibitor, optionallySB431542.
 39. The method of any one of claims 1 to 38, wherein the hPSCsare an induced pluripotent stem cell (iPSC) line and/or a humanembryonic stem cell (hESC) line.
 40. The method of claim 39, wherein theiPSC is a fibroblast derived iPSC line.
 41. A population ofcardiovascular lineage cells and/or cells epicardial derived cell (EPDC)produced according to the method of any one of claims 1 to
 40. 42. A kitcomprising: 1) an agent for measuring expression of a marker expressedon a cardiovascular lineage cell or an EPDC, the marker selected fromKDR, PDGFRalpha, NKX2-5+, WT1, ZO1, EMT marker such as SNAI1 and/orSNAI2, a mesenchymal marker such as vimentin and/or CD90 and/or a smoothmuscle marker such as SMA, a smooth muscle gene optionally CNN1, MYH11,TAGLN and SMTN, TCF21, retinol dehydrogenase, and/or Aldefluor activity;and/or 2) a component for inducing differentiation of a cardiovascularlineage cell population, the component selected from a BMP component ina concentration for specifying cardiomyocytes or comprising a BMPcomponent and a Wnt component for epicardial specification.
 43. A methodfor identifying a cardiovascular cell differentiation promotion agentcomprising the steps: (a) contacting a test cell population with a testagent at a step in any one of claims 1 to 40; (b) monitoring forexpression of a marker selected from KDR, PDGFRalpha, NKX2-5+, WT1, ZO1,a mesenchymal marker such as vimentin and/or CD90 and/or a smooth musclemarker such as SMA, a smooth muscle gene optionally CNN1, MYH11, TAGLNand SMTN, TCF21, retinol dehydrogenase, and/or Aldefluor activity levelsin the test cell population and a control; and (c) identifying the testagent as a cardiovascular cell differentiating promotion agent when thetest agent induces and/or increases expression of the cardiovascularmarker.